Solutions For Providers
Provider Data Accuracy
Update your data in one place
PRIME can coordinate and provide data updates to all your affiliated Health Plans, making Provider data validation easy and convenient.
Health Plan Coordination
PRIME works closely with Health Systems and Provider groups, providing 100% coordination of Provider data updates to all affiliated Health Plans.
PRIME synchronizes Provider data updates on your behalf and determines variances between your data and the Health Plans’ based on their criteria, ensuring that Health Plans receive accurate, complete, and timely data from your organization.
Concierge Coordination and Support
If you don’t have time to update your profile online, give us a call at +1-856-886-8088. Our agents will update your data at your convenience.
Ease of Use
PRIME offers a self-service portal for Providers to update data conveniently. PRIME’s call center is also available for Providers to speak with an agent to assist with data updating. Providers who utilize PRIME enjoy efficient and automated data updates.
Roster Integration
Our technology provides file integration of rosters and also supports direct EHR integration.
Health Plan Updating
We reconcile any differences between your current Provider data and a Health Plan’s version of your data in their systems. We communicate directly with your affiliated Health Plans to make all necessary data updates.
Roster Integration
PRIME integrates with top Provider Data Management (PDMS) & EHR Systems, as well as Proprietary Health Plan Provider Data systems
Support for the No Surprises Act
The No Surprises Act requires insurance agencies to maintain accurate provider directories. The legislation mandates that Health Plans must:
- Maintain Provider data within directories at least every 90 days
- Update Provider data in downstream systems within 2 days
- Remove unverified Providers from directories.
PRIME’s capabilities are aligned with each of these requirements, which are in addition to the existing CMS regulations applicable to Medicare, Medicaid, and QHP. PRIME integrates with popular EHR systems like EPIC and supports secure file integrations that facilitate the bi-directional workflows of Health Systems and Provider groups.
Provider Training
Online Training
PRIME uses state-of-the-art technology to provide a positive, structured, and completely customizable training experience. We ensure that network providers are fully trained and ready for delivering quality care, including CMS Special Needs Plan Model of Care (SNP MOC) and more!
Build Competencies
Log attendance lists and incorporated competencies related to specific job functions are included. Competency modules include Integrity and Compliance, Fraud and Abuse, Cultural Competency, HIPAA, and Confidentiality.
Follow-Up
Our direct outreach methods provide personal follow-ups for your Providers. We track their progress and send each Provider a certificate upon completion.
